August 26th, 2011 by Davis Liu, M.D. in News, Opinion
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The New York Times recently published an article titled, Finding a Quality Doctor, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related to diabetes. From the August 2010 New England Journal of Medicine article, Dr. Ofri notes that her report card showed the following – 33% of patients with diabetes have glycated hemoglobin levels at goal, 44% have cholesterol levels at goal, and a measly 26% have blood pressure at goal. She correctly notes that these measurements alone aren’t what makes a doctor a good quality one, but rather the areas of interpersonal skills, compassion, and empathy, which most of us would agree constitute a doctor’s bedside manner, should count as well.
Her article was simply to illustrate that “most doctors are genuinely doing their best to help their patients and that these report cards might not be accurate reflections of their care” yet when she offered this perspective, a contrary point of view, many viewed it as “evidence of arrogance.”
She comforted herself by noting that those who criticized her were “mostly [from] doctors who were not involved in direct patient care (medical administrators, pathologists, radiologists). None were in the trenches of primary care.”
From the original NEJM article, Dr. Ofri concluded Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
August 26th, 2011 by Jessie Gruman, Ph.D. in Research
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Do you suffer from decision fatigue when you are sick or anxious or overwhelmed by bad health news? Does your doctor make less well-reasoned decisions about the 10th patient she sees before lunch? How about the surgeon during his second operation of the day? How about the radiologist reading the last mammogram in a daily batch of 60?
A provocative article by John Tierney in Sunday’s NYTimes Magazine adds a new layer of complexity to the body of knowledge collecting around decision-making processes. Considerable news reporting has focused on how cognitive biases influence our judgment and how many of us experience the abundance of choices available to us as a burden rather than a privilege. This article adds to that understanding: Our decision-making abilities appear to be powerfully affected by the demands of repeated decision making as they interact with depleted blood glucose levels. That fatigue mounts over a day of making decisions and as blood glucose levels fall between meals. In response, we tend to either make increasingly impulsive decisions without considering the consequences or to make no decisions at all. Tierney describes a study analyzing 1,100 parole decisions by judges over the course of a year: “Prisoners who appeared early in the morning received parole about 70 percent of the time, while those who appeared late in the day were paroled less than 10 percent of the time.”
The effects reported in the article were Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
August 25th, 2011 by RamonaBatesMD in Research
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I was alerted to this Archives of Surgery article (full reference below) by MedPage Today: Role Playing Boosts Surgical Residents’ Bedside Manner.
I find it intriguing. Role playing gives you a chance for a “do-over” when you make a social or communication faux pas.
So much of medicine is communication. Those of us who have been at it for years, deliver bad news differently (learned the hard way) now than we did previously. You choose your words more carefully (though I still occasionally screw up). Some words are more emotionally charged than others. Some patients want more information than others.
The University of Connecticut Health Center conducted a prospective study of a pilot project designed to teach surgical residents patient-centered communication skills.
The study offered Read more »
*This blog post was originally published at Suture for a Living*
August 25th, 2011 by Bryan Vartabedian, M.D. in Opinion
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Perhaps the biggest challenges facing the next generation of physicians is information overload. The problem: Unlimited information on limited human bandwidth. There’s simply too much to read and see. For physicians the problem is compounded by a perceived responsibility to keep up.
But the idea that we actually can have our hands around everything is reflective of a time when doctors actually could know all there was to know. Many of today’s physicians were raised at a time when a paper inbox and a pile of journals represented their only information inputs. But things are very different now.
Here are a few ideas on controlling your inputs: Read more »
*This blog post was originally published at 33 Charts*
August 25th, 2011 by DrWes in Opinion, Research
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A new report published online in the Journal of the American College of Cardiology and reported in theHeart.org and elsewhere, suggests the infection rate of cardiac implantable electronic devices (CEID’s) between 1993 and 2008 has greatly increased from 1.53% in 2004 to 2.41% in 2008 (p < 0.001) with a dramatic rise in 2005:
Click image to enlarge
The authors explain this sudden increase on the basis of comorbities: Read more »
*This blog post was originally published at Dr. Wes*
